Urg. I'm at the office - yes, on Saturday - and I've just spent roughly the last two and a half hours completing a multimedia educational module on the subjects of coding, chart documentation and fraud awareness. The deadline for completion of said module is November 30. In case you hadn't noticed, that's today, explaining why I am spending a large chunk of my Thanksgiving weekend here.

Welcome to the face of modern medicine.

The old fantasy of a doctor hanging out his/her shingle and going into business for himself/herself is now just that - a fantasy. Between the requirements of OSHA workplace safety regulations, ever-evolving legislation on billing fraud, and chart audits/office inspections by managed care programs, operating a physician's office really requires a large, full-time administrative staff to keep up with everything.

One of the physicians who recently resigned from the group is going into practice for himself. From what I've heard secondhand, his goal is to operate a cash-only practice (yeah, like cash patients are just lying around on the ground waiting to be picked up). The only way to avoid this bureaucratic avalanche, however, is to operate that kind of practice. The minute a physician accepts Medicare or MedicAid/MediCal, or signs a contract with a managed care organization, he has just let himself in for more audits and second-guess management than you can possibly imagine. There's no way out of it.

My father, now retired, operated his own practice for thirty years; he took it over from an elderly, well-established local physician who had practiced since the Thirties (maybe even before that). There are many great stories about his practice I'd like to tell later when I get the time, which I don't have right now. The point I'm really trying to make though can be epitomized in something Dad told me about ten years ago when the new OSHA regulations went into effect: he said there was no way he could comply with all the new requirements and continue to operate his practice; he couldn't afford it and it wasn't physically possible.

"So what are you going to do?" I asked. In case you don't know, OSHA (stands for Occupational Safety and Health Administration; it's a creation of the federal government to ensure safe workplace conditions) inspectors can walk into a physician's office for a formal inspection at any time, and are not required to supply you with any sort of warning beforehand. Being found in violation of OSHA can result in being fined up to $10,000. Per day.

He said, "I'm going to keep going for now, try to sell the practice, and if they audit me before I sell it I'm going to close it down." And he meant it. For the last two years before he sold it, he ran his practice on a knife's edge, knowing he might have to quit forever on a day's notice. He didn't have cockroaches in the exam rooms or anything blatantly dangerous or unsanitary - my dad has always been proud of his office and tried to run it in a professional way. He just couldn't keep up with the huge costs and/or investment in equipment mandated by the new OSHA requirements.

So for all of you out there, if you want to know why visiting the family doctor isn't the small-town, intimate experience it used to be, if you feel like you're just another patient on an assembly line when you go there - this is why. We can't practice medicine like that any more because documenting the physician-patient encounter is now more important than the encounter itself. The code we select to describe your visit may require more thought from us than which antibiotic or high blood pressure medicine we choose to give you.